Psychopharmacology Practice Questions

Q: Which of the following drugs is classified as a novel antidepressant?

Vilazodone. ***Vilazodone*** - Classified as a **serotonin partial agonist-reuptake inhibitor (SPARI)**, it combines **SSRI** activity with **5-HT1A receptor partial agonism**. - Its unique mechanism of action contributes to its status as a **novel antidepressant**, often associated with a lower incidence of sexual side effects compared to traditional SSRIs. *Trazodone* - This is an older **serotonin antagonist and reuptake inhibitor (SARI)**, primarily utilized today at lower doses for its **sedative-hypnotic properties** rather than as a first-line antidepressant. - It is not classified as a novel antidepressant due to its chemical structure and established long-term history of clinical use. *Blonanserin* - This is an **atypical antipsychotic** drug, not an antidepressant, primarily used for the treatment of **schizophrenia**. - It functions as a **dopamine D2 and serotonin 5-HT2A receptor antagonist**. *Etizolam* - This is a **thienodiazepine derivative**, structurally related to **benzodiazepines**, primarily used for its **anxiolytic**, hypnotic, and anticonvulsant effects. - It acts as a **GABA-A receptor positive allosteric modulator** and has no primary antidepressant classification.

Q: Which antipsychotic has anti-suicidal properties?

clozapine. **Explanation:** **Clozapine** is the correct answer because it is the only antipsychotic with a specifically FDA-approved indication for reducing the risk of recurrent suicidal behavior in patients with schizophrenia or schizoaffective disorder. This anti-suicidal effect is independent of its primary antipsychotic action and is believed to be mediated by its unique modulation of serotonergic (5-HT2A) and noradrenergic systems, which helps reduce impulsivity and aggression. **Analysis of Incorrect Options:** * **B. Chlorpromazine:** A typical (first-generation) antipsychotic primarily used for acute psychosis. While it treats positive symptoms, it has no proven specific anti-suicidal properties and may even worsen depressive symptoms in some patients. * **C. Aripiprazole:** A partial dopamine agonist. While effective for mood stabilization and augmentation in depression, it does not carry a specific indication for suicide prevention. * **D. Amisulpride:** A substituted benzamide that is effective for both positive and negative symptoms of schizophrenia, but lacks evidence for a direct anti-suicidal effect. **High-Yield Clinical Pearls for NEET-PG:** * **The "Rule of Two":** There are two main drugs in psychiatry known for reducing suicide risk: **Clozapine** (in Schizophrenia) and **Lithium** (in Bipolar Disorder). * **Clozapine Monitoring:** Due to the risk of **agranulocytosis**, regular monitoring of Absolute Neutrophil Count (ANC) is mandatory. * **Other Side Effects:** Clozapine is associated with the highest risk of seizures (dose-dependent), sialorrhea (drooling), myocarditis, and metabolic syndrome among antipsychotics. * **Indication:** It remains the gold standard for **Treatment-Resistant Schizophrenia** (defined as failure of two adequate trials of other antipsychotics).

Q: A 30-year-old male presents with a history of abnormal, excessive blinking and grunting sounds. He has no control over these symptoms, which have increased in frequency. Which of the following medications can be used for the treatment of this condition?

Risperidone. ### Explanation **Diagnosis:** The clinical presentation of involuntary motor tics (excessive blinking) and vocal tics (grunting sounds) in a young patient is characteristic of **Tourette Syndrome (TS)**. **1. Why Risperidone is Correct:** The pathophysiology of Tourette Syndrome involves **dopaminergic overactivity** in the nigrostriatal pathway and basal ganglia. Treatment focuses on dopamine modulation. **Risperidone**, an atypical antipsychotic (D2 and 5-HT2A receptor antagonist), is a first-line pharmacological treatment for tics. It is often preferred over typical antipsychotics (like Haloperidol or Pimozide) due to a lower risk of extrapyramidal side effects (EPS) while effectively suppressing both motor and vocal tics. **2. Why the Other Options are Incorrect:** * **A. Carbamazepine:** An antiepileptic and sodium channel blocker used for focal seizures and trigeminal neuralgia; it has no role in treating tics. * **B. Imipramine:** A Tricyclic Antidepressant (TCA) used for nocturnal enuresis and depression. While some TCAs are used in ADHD, they are not indicated for tic disorders. * **C. Methylphenidate:** A CNS stimulant used for ADHD. It can actually **exacerbate or unmask tics** in susceptible individuals due to increased dopamine release. **3. NEET-PG High-Yield Pearls:** * **FDA-approved drugs for TS:** Haloperidol, Pimozide, and Aripiprazole. * **First-line non-pharmacological therapy:** Comprehensive Behavioral Intervention for Tics (CBIT). * **Alpha-2 Agonists:** Clonidine and Guanfacine are often used first-line if the patient has comorbid ADHD. * **Comorbidities:** ADHD and OCD are the most common psychiatric conditions associated with Tourette Syndrome.

Q: Which of the following antipsychotic medications carries the least risk of metabolic side effects?

Ziprasidone. **Explanation:** The metabolic profile of second-generation (atypical) antipsychotics is a high-yield topic for NEET-PG. These drugs are associated with weight gain, dyslipidemia, and insulin resistance due to their affinity for H1 and 5-HT2C receptors. **Why Ziprasidone is Correct:** **Ziprasidone** (along with Aripiprazole and Lurasidone) is considered **metabolically neutral**. It has a very low affinity for histamine (H1) receptors, resulting in minimal weight gain and negligible impact on blood glucose or lipid levels. While it carries a risk of QTc prolongation, its metabolic safety profile is superior to most other atypicals. **Analysis of Incorrect Options:** * **Clozapine (D) & Olanzapine (B):** These are the **worst offenders**. They have the highest risk of significant weight gain, sedation, and new-onset Diabetes Mellitus. Clozapine is the most metabolic-heavy, followed closely by Olanzapine. * **Risperidone (A):** This drug carries a **moderate risk**. While less severe than Olanzapine, it still causes significant weight gain and is notably associated with the highest risk of hyperprolactinemia among atypicals. **NEET-PG High-Yield Pearls:** * **Mnemonic for Metabolic Risk (Highest to Lowest):** "**C**ome **O**n **Q**uietly **R**isperidone **A**nd **Z**iprasidone" (**C**lozapine > **O**lanzapine > **Q**uetiapine > **R**isperidone > **A**ripiprazole/**Z**iprasidone). * **Ziprasidone** must be taken **with food** (minimum 500 calories) for adequate absorption. * **Monitoring:** Patients on Clozapine/Olanzapine require regular monitoring of BMI, waist circumference, fasting glucose, and lipid profiles.

Q: A patient with maniac depressive psychosis is on lithium, clozapine, and fluphenazine. During the course of treatment, he developed seizures, tremors, excessive thirst, and recurrent episodes of urination. Which drug is most likely responsible for these complications?

Lithium. ### Explanation The correct answer is **Lithium**. This question tests the ability to differentiate the side effect profiles of multiple psychotropic drugs administered simultaneously. **Why Lithium is the correct answer:** Lithium has a narrow therapeutic index and is notorious for multisystem side effects. The symptoms described in the patient are classic manifestations of Lithium toxicity and its physiological effects: * **Excessive thirst (Polydipsia) and Recurrent urination (Polyuria):** Lithium causes **Nephrogenic Diabetes Insipidus** by interfering with the action of ADH (Vasopressin) on the collecting ducts of the kidney. * **Tremors:** Fine tremors are a common side effect, while coarse tremors often indicate Lithium toxicity. * **Seizures:** At toxic levels (>2.0 mEq/L), Lithium is highly neurotoxic and can precipitate seizures. **Why other options are incorrect:** * **Clozapine:** While Clozapine is the antipsychotic most strongly associated with a dose-dependent risk of **seizures**, it does not cause polyuria or polydipsia. Its hallmark side effects are agranulocytosis, sialorrhea (drooling), and myocarditis. * **Fluphenazine:** A high-potency typical antipsychotic primarily associated with **Extrapyramidal Side Effects (EPS)** like dystonia, akathisia, and parkinsonism. It does not cause the renal symptoms described. **High-Yield Clinical Pearls for NEET-PG:** * **Monitoring:** Therapeutic drug monitoring (TDM) is essential for Lithium. Target serum levels: 0.6–1.2 mEq/L (Prophylaxis/Maintenance) and 0.8–1.5 mEq/L (Acute Mania). * **Renal Impact:** Lithium is the drug of choice for Bipolar Disorder but is contraindicated in renal failure. * **L-C-S Triad:** Remember **L**ithium, **C**lozapine, and **S**ertraline (in SSRI withdrawal) can all lower the seizure threshold, but only Lithium explains the constellation of renal and neurological symptoms provided.

Q: What is the best choice of antianxiety agent for a 40-year-old woman with generalized anxiety disorder and a history of benzodiazepine abuse?

buspirone. **Explanation:** The correct answer is **Buspirone**. **Why Buspirone is the best choice:** Generalized Anxiety Disorder (GAD) often requires long-term pharmacological management. In a patient with a history of **substance abuse or benzodiazepine (BZD) dependence**, BZDs are contraindicated due to their high potential for addiction, tolerance, and withdrawal. * **Mechanism:** Buspirone is a **5-HT1A partial agonist**. * **Clinical Advantage:** Unlike BZDs, it has **no potential for abuse or addiction**, does not cause sedation, and does not potentiate the effects of alcohol. This makes it the ideal "non-addictive" alternative for chronic anxiety in high-risk patients. **Why other options are incorrect:** * **Zolpidem (A):** This is a non-benzodiazepine sedative-hypnotic ("Z-drug") used primarily for insomnia, not GAD. While it has a different structure, it still carries a risk of dependence and misuse. * **Flurazepam (B) & Clonazepam (C):** Both are benzodiazepines. Flurazepam is long-acting and used for insomnia; Clonazepam is used for GAD and panic disorder. Both are strictly avoided in patients with a history of drug abuse due to the risk of relapse and physiological dependence. **NEET-PG High-Yield Pearls:** * **Lag Period:** Buspirone takes **2–4 weeks** to show therapeutic effects; it is not useful for acute anxiety attacks (unlike BZDs). * **Side Effects:** Dizziness, nausea, and headache are common. It does *not* cause muscle relaxation or anticonvulsant effects. * **Drug of Choice for GAD:** While SSRIs/SNRIs are first-line, Buspirone is a specific high-yield answer for GAD patients with **addiction history**.

Q: Benzodiazepines are used in the treatment of somnambulism because they?

Decrease the duration of NREM stages III and IV. **Explanation:** **Somnambulism (Sleepwalking)** is a parasomnia that occurs during **NREM Stage N3 (Stage III and IV)**, also known as slow-wave sleep (SWS) or deep sleep. This is the stage characterized by high-arousal thresholds and rhythmic delta waves. **Why the correct answer is right:** Benzodiazepines (such as Diazepam or Alprazolam) are effective in treating somnambulism because they **suppress and decrease the duration of NREM Stage III and IV sleep**. By reducing the time a patient spends in these deep sleep stages, the physiological window in which sleepwalking occurs is minimized, thereby reducing the frequency of episodes. **Why the incorrect options are wrong:** * **Option A:** Increasing NREM Stage III and IV would theoretically increase the risk and frequency of sleepwalking episodes, as the disorder originates in these stages. * **Option B & D:** While Benzodiazepines are known to **decrease REM sleep** (Option D), this is not the primary reason they are used for somnambulism. Somnambulism is an NREM disorder; REM-related disorders include Nightmares and REM Sleep Behavior Disorder (RBD). Therefore, the effect on NREM is the clinically relevant mechanism here. **High-Yield Clinical Pearls for NEET-PG:** * **Timing:** Sleepwalking typically occurs during the **first third** of the night (when NREM sleep is most abundant). * **Amnesia:** Patients usually have complete amnesia regarding the episode the following morning. * **Management:** The first line of management is usually **safety precautions** and sleep hygiene. Pharmacotherapy (Benzodiazepines) is reserved for refractory or dangerous cases. * **Differential:** Unlike sleepwalking, **Nightmares** occur during REM sleep, usually in the later part of the night, and the patient has vivid recall.

Question 1

Which of the following drugs is classified as a novel antidepressant?

Accepted Answer

Vilazodone

Answer

Trazodone

Answer

Blonanserin

Answer

Etizolam

Question 2

Which instruction is correct for a patient using nicotine replacement therapy?

Accepted Answer

Patient should avoid liquids like tea or coffee 15 minutes before using gum or lozenge

Answer

Gums are more effective than lozenges

Answer

Correct timing of doses

Answer

Proper storage of nicotine products

Question 3

A 34-year-old woman with bipolar I disorder has been maintained on lithium carbonate 900 mg/day for the past 18 months with good mood stabilisation. She presents to the outpatient clinic complaining of a worsening skin condition that began approximately 3 months after starting lithium. Her serum lithium level is 0.8 mEq/L (therapeutic range). She has no prior personal or family history of skin disease. Over the past 6 weeks, she has been using a moderate-potency topical corticosteroid prescribed by her dermatologist with no meaningful improvement; the eruption has continued to spread and now involves the face, scalp, and upper back, causing significant distress and social impairment. A dermatology referral photograph is shown (Image 1). Which of the following is the most appropriate next step in management?

Accepted Answer

B. Discontinue lithium and switch to sodium valproate as the mood stabiliser

Answer

A. Reduce the lithium dose and add a higher-potency topical corticosteroid while continuing mood stabilisation

Answer

C. Continue lithium at the same dose and refer for isotretinoin therapy

Answer

D. Discontinue lithium immediately and initiate electroconvulsive therapy for mood stabilisation

Question 4

A 35-year-old woman started on haloperidol for acute psychosis develops fever (102°F/38.9°C), severe muscle rigidity, altered mental status, and autonomic instability 3 days after medication initiation. Laboratory studies show creatine kinase of 15,000 U/L and white blood cell count of 16,000/mm³. Apply the most appropriate management approach.

Accepted Answer

Discontinue haloperidol and administer bromocriptine and dantrolene

Answer

Switch to atypical antipsychotic immediately

Answer

Continue haloperidol and add antipyretics

Answer

Perform lumbar puncture to rule out meningitis

Answer

Administer antibiotics for presumed sepsis

Question 5

Which antipsychotic has anti-suicidal properties?

Accepted Answer

clozapine

Answer

chlorpromazine

Answer

aripiprazole

Answer

amisulpride

Question 6

A 30-year-old male presents with a history of abnormal, excessive blinking and grunting sounds. He has no control over these symptoms, which have increased in frequency. Which of the following medications can be used for the treatment of this condition?

Accepted Answer

Risperidone

Answer

Carbamazepine

Answer

Imipramine

Answer

Methylphenidate

Question 7

Which of the following antipsychotic medications carries the least risk of metabolic side effects?

Accepted Answer

Ziprasidone

Answer

Risperidone

Answer

Olanzapine

Answer

Clozapine

Question 8

A patient with maniac depressive psychosis is on lithium, clozapine, and fluphenazine. During the course of treatment, he developed seizures, tremors, excessive thirst, and recurrent episodes of urination. Which drug is most likely responsible for these complications?

Accepted Answer

Lithium

Answer

Clozapine

Answer

Fluphenazine

Answer

None of the above

Question 9

What is the best choice of antianxiety agent for a 40-year-old woman with generalized anxiety disorder and a history of benzodiazepine abuse?

Accepted Answer

buspirone

Answer

zolpidem

Answer

flurazepam

Answer

clonazepam

Question 10

Benzodiazepines are used in the treatment of somnambulism because they?

Accepted Answer

Decrease the duration of NREM stages III and IV

Answer

Increase the duration of NREM stages III and IV

Answer

Increase the duration of REM sleep

Answer

Decrease the duration of REM sleep

Psychopharmacology — MCQs

Psychopharmacology — MCQs

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